CAJ | 학술논문

目的：探讨经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBT)联合膀胱灌注化疗及静脉化疗治疗浸润性膀胱癌的临床疗效。方法影像及病理均明确诊断为浸润性膀胱癌不能耐受或拒绝行根治性膀胱切除术患者20例,肿瘤直径1.8~5.0 cm,病理分级 G211例,G39例,TNM分期T2a 9例,T2b 10例,T4a 1例。采用 TURBT切除肿瘤至膀胱壁外脂肪层,其中1例肿瘤侵犯前列腺者同时行经尿道前列腺电切术,切除范围至肿瘤基底部周围2 cm正常膀胱黏膜。术后 GC方案(吉西他滨+顺铂)静脉化疗,每三周为1个周期；吡柔比星膀胱灌注化疗,每周一次。每三个月复查膀胱镜评估肿瘤复发情况。结果20例患者手术顺利,手术时间35~100 min,围手术期未见严重并发症。术后病理报告均为浸润性尿路上皮癌。化疗后出现白细胞下降4例,恶心、食欲减退等胃肠道反应6例,对症处理后均好转。术后随访3~24个月,平均12个月。术后6个月复发1例,术后12个月复发1例,术后24个月复发1例。复发病例中T4a 1例,T2b 2例。术后6个月复发者死于肿瘤远处转移。结论 TURBT 联合化疗治疗浸润性膀胱癌有一定疗效,可作为保留膀胱的一种综合治疗方法。
목적：탐토경뇨도방광종류전절술(transurethral resection of bladder tumor, TURBT)연합방광관주화료급정맥화료치료침윤성방광암적림상료효。방법영상급병리균명학진단위침윤성방광암불능내수혹거절행근치성방광절제술환자20례,종류직경1.8~5.0 cm,병리분급 G211례,G39례,TNM분기T2a 9례,T2b 10례,T4a 1례。채용 TURBT절제종류지방광벽외지방층,기중1례종류침범전렬선자동시행경뇨도전렬선전절술,절제범위지종류기저부주위2 cm정상방광점막。술후 GC방안(길서타빈+순박)정맥화료,매삼주위1개주기；필유비성방광관주화료,매주일차。매삼개월복사방광경평고종류복발정황。결과20례환자수술순리,수술시간35~100 min,위수술기미견엄중병발증。술후병리보고균위침윤성뇨로상피암。화료후출현백세포하강4례,악심、식욕감퇴등위장도반응6례,대증처리후균호전。술후수방3~24개월,평균12개월。술후6개월복발1례,술후12개월복발1례,술후24개월복발1례。복발병례중T4a 1례,T2b 2례。술후6개월복발자사우종류원처전이。결론 TURBT 연합화료치료침윤성방광암유일정료효,가작위보류방광적일충종합치료방법。
Objective To evaluate the clinical efficacy of transurethral resection of bladder tumor (TURBT)combined with intravesical chemotherapy and intravenous chemotherapy for inva-sive bladder cancer. Methods 20 patients,who were diagnosed with invasive bladder cancer by Imaging and pathology and not tolerating or refusing radical cystectomy were treated by TURBT.Of the 20 patients,the tumor diameters were 1.8 to 5.0 cm,11 cases were G2 and 9 cases were G3 , while TNM stage T2a 9 cases were in T2a stage,10 cases in T2b and 1 case in T4a stage.The tumors were resected to the bladder wall outer layer of fat,while transurethral resection of the prostate was simultaneous performed in 1 case with prostatic invasion.Postoperative GC schedule (gemcitabine +cisplatin)chemotherapy was implemented every three weeks as a cycle;Pirarubicin intravesical chemotherapy was administered once a week.Cystoscopy was performed every three months to as-sess the tumor recurrence. Results The tumors of 20 patients were resected completely.Opera-tive time ranged from 35 to 100 min,no serious complications occurred during the operation.The patients were confirmed as invasive transitional cell carcinoma by pathological examination.After chemotherapy,leukopenia appeared in four patients,and gastrointestinal reactions such as nausea or loss of appetite occurred in six patients,which were improved after symptomatic treatment.Patients were followed up from 3 to 24 months (average of 12 months).During the follow-up period,recurrence happened in three pa-tient after 6 months,12 months and 24 months respectively,while 1case died of bladder cancer metastasis. Conclusions TURBT in combination with chemotherapy is quite efficient for invasive bladder cancer patients and can be used as a compre-hensive treatment for bladder perservation.